Acta Neuropathologica

, Volume 120, Issue 6, pp 765–776

IgG4-related meningeal disease: clinico-pathological features and proposal for diagnostic criteria

  • Katherine M. Lindstrom
  • John B. Cousar
  • M. Beatriz S. Lopes
Original Paper

DOI: 10.1007/s00401-010-0746-2

Cite this article as:
Lindstrom, K.M., Cousar, J.B. & Lopes, M.B.S. Acta Neuropathol (2010) 120: 765. doi:10.1007/s00401-010-0746-2
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Abstract

IgG4-related disease has evolved from originally being recognized as a form of pancreatitis to encompass diseases of numerous organs including the hypophysis and one reported case of dural involvement. A search of the University of Virginia, Division of Neuropathology files for 10 years identified ten cases of unexplained lymphoplasmacytic meningeal inflammation that we then evaluated using immunohistochemical stains for IgG4 and IgG. Ten control cases including sarcoidosis (4), tuberculosis (1), bacterial abscess (2), Langerhans cell histiocytosis (2), and foreign body reaction (1) were also examined. The number of IgG4-positive plasma cells was counted in five high power fields (HPFs) and an average per HPF was calculated. Cases that contained greater than ten IgG4-positive cells/HPF were considered to be IgG4-related. Five of the study cases met these criteria, including one case of leptomeningeal inflammation. All cases exhibited the typical histological features of IgG4-related disease including lymphoplasmacytic inflammation, fibrosis, and phlebitis. The dural-based lesions appear to represent a subset of the cases historically diagnosed as idiopathic hypertrophic pachymeningitis. While the leptomeningeal process most closely resembles non-vasculitic autoimmune inflammatory meningoencephalitis. Given these findings, IgG4-related meningitis should be considered in the differential diagnosis of meningeal inflammatory lesions after stringent clinical and histologic criteria are used to rule out other possible diagnoses.

Keywords

IgG4-related sclerosing diseaseIgG4-related pachymeningitisNon-vasculitic autoimmune inflammatory meningoencephalitisIdiopathic hypertrophic pachymeningitisCentral nervous system

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Katherine M. Lindstrom
    • 1
  • John B. Cousar
    • 2
  • M. Beatriz S. Lopes
    • 1
  1. 1.Division of Neuropathology, Department of PathologyUniversity of Virginia School of MedicineCharlottesvilleUSA
  2. 2.Division of Hematopathology, Department of PathologyUniversity of Virginia School of MedicineCharlottesvilleUSA